{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T06:13:28Z","timestamp":1790835208055,"version":"4.1.0"},"reference-count":38,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T00:00:00Z","timestamp":1775520000000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003793","name":"Swedish Heart-Lung Foundation","doi-asserted-by":"publisher","award":["20210030"],"award-info":[{"award-number":["20210030"]}],"id":[{"id":"10.13039\/501100003793","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003793","name":"Swedish Heart-Lung Foundation","doi-asserted-by":"publisher","award":["20210581"],"award-info":[{"award-number":["20210581"]}],"id":[{"id":"10.13039\/501100003793","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003793","name":"Swedish Heart-Lung Foundation","doi-asserted-by":"publisher","award":["20240726"],"award-info":[{"award-number":["20240726"]}],"id":[{"id":"10.13039\/501100003793","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Avtal om L\u00e4karutbildning och Forskning\/Medical Training and Research Agreement","award":["ALFGBG-938453"],"award-info":[{"award-number":["ALFGBG-938453"]}]},{"name":"Avtal om L\u00e4karutbildning och Forskning\/Medical Training and Research Agreement","award":["ALFGBG-971130"],"award-info":[{"award-number":["ALFGBG-971130"]}]},{"name":"Avtal om L\u00e4karutbildning och Forskning\/Medical Training and Research Agreement","award":["ALFGBG-978954"],"award-info":[{"award-number":["ALFGBG-978954"]}]},{"name":"Avtal om L\u00e4karutbildning och Forskning\/Medical Training and Research Agreement","award":["ALFGBG-1006729"],"award-info":[{"award-number":["ALFGBG-1006729"]}]},{"DOI":"10.13039\/501100006636","name":"Forskningsr\u00e5det f\u00f6r h\u00e4lsa, arbetsliv och v\u00e4lf\u00e4rd","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100006636","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Research Council for Health, Working Life, and Welfare","award":["2024-01711"],"award-info":[{"award-number":["2024-01711"]}]},{"name":"Research Council for Environment, Agricultural Sciences and Spatial Planning","award":["2020-02828"],"award-info":[{"award-number":["2020-02828"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Rationale<\/jats:title>\n                    <jats:p>Chronic obstructive pulmonary disease (COPD) exacerbations, often triggered by viral infections like COVID-19, are associated with increased cardiovascular risk. We hypothesized that COVID-19\u2013related exacerbations carry higher short-term cardiovascular and mortality risks than non-COVID-19\u2013related exacerbations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To compare 28-day risk of stroke, pulmonary embolism (PE), acute myocardial infarction (AMI), major adverse cardiovascular events (MACE), and all-cause mortality following COVID-19\u2013related vs non-COVID-19\u2013related COPD exacerbations and assess variation across the pandemic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using Swedish national registers, we identified COPD with moderate (treated with oral corticosteroids with\/without antibiotics) or severe (hospitalized) exacerbations from March 2020 to June 2023. Exacerbations with infection, hospitalization, or intensive care admission for COVID-19 were defined as COVID-19 related. A target trial was emulated and adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) were estimated for each outcome, stratified by exacerbation severity and COVID-19 variants.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 266\u200a273 exacerbations (87.2% moderate, 12.8% severe), 5425 (2%) were COVID-19 related. COVID-19\u2013related vs non-COVID-19\u2013related moderate exacerbations were associated with risk of PE (aHR, 2.26 [95% CI, 1.49-3.42]), overall cardiovascular events (1.94 [1.47-2.56]), MACE (1.88 [1.28-2.76]), and mortality (4.58 [4.06-5.17]), but not significantly with AMI and stroke. Severe COVID-19\u2013related exacerbations were only associated with higher mortality (1.46 [1.28-1.66]). Cardiovascular risks were highest during pre-Alpha and Delta for moderate exacerbations. Mortality remained elevated for both moderate and severe exacerbations, particularly during the same periods.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>COVID-19\u2013related exacerbations increased MACE, short-term cardiovascular, and mortality risks, mainly for moderate exacerbations, with attenuation during Alpha and Omicron, highlighting the need for proactive cardiovascular care during respiratory outbreaks.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/annalsats\/aaoag084","type":"journal-article","created":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T18:43:23Z","timestamp":1775673803000},"page":"1476-1487","source":"Crossref","is-referenced-by-count":1,"title":["Cardiovascular and mortality risks following COVID-19\u2013related versus non-COVID-19\u2013related chronic obstructive pulmonary disease 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Ghent,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1848-2867","authenticated-orcid":false,"given":"Ailiana","family":"Santosa","sequence":"additional","affiliation":[{"name":"School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg , Gothenburg,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1189-9950","authenticated-orcid":false,"given":"Carl","family":"Bonander","sequence":"additional","affiliation":[{"name":"School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg , Gothenburg,","place":["Sweden"]},{"name":"Centre for Societal Risk Research, Karlstad University , 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